Because successful engagement of non-gay-identifying African American MSM/MSMW is essential to the reduction of HIV transmission and substance abuse in Black communities, findings call for drug treatment approaches that acknowledge and accept diverse sexuality in clients. Some of those in treatment for substance abuse indicated that a readiness to admit their same-sex activity and come to terms with their homosexuality/bisexuality was necessary for recovery. Participants described alcohol use and drug transactions, use, and addiction as motivating sex with men, allowing and rationalizing same-sex activity and unprotected sex, and facilitating access to male sex partners. Drug use was identified as playing a central role in same-sex sexuality for many African American MSM/MSMW. Alcohol, crack cocaine, and crystal methamphetamine were the primary drugs mentioned by participants. Focus group transcripts were analyzed using consensual qualitative research techniques. A total of 29 men self-identified as HIV-infected and 17 self-identified as uninfected. Between July 2005 and February 2006, we conducted seven focus groups with 46 predominately low socioeconomic status African American MSM/MSMW. We examined the role of drug use and addiction in same-sex sexuality among non-gay-identifying African American men who have sex with men or with both men and women (MSM/MSMW).
